Effect of phototherapy on the diagnostic accuracy of transcutaneous bilirubin in preterm infants

Gaurav Nagar, Manoj Kumar

Journal of Clinical Neonatology 2017 6(3):148-153

Objectives: The objective of this study was to evaluate the diagnostic accuracy of JM-103 transcutaneous bilirubinmeter (TcB) in preterm infants during phototherapy (PT) and in post-PT phase. Methods: This was a prospective cohort study. Infants born between 28 and 35 weeks of gestation and at <28 days of postnatal age were eligible if they required bilirubin estimation during the NICU stay. TcB was measured within 30 minutes of the blood sampling for serum bilirubin, at forehead and sternum. Mean difference (±standard deviation [SD]) and 95% limits of agreement between TcB and total serum bilirubin (TSB) were calculated by analyzing Bland–Altman difference plots. We also calculated correlation coefficients. Results: Ninety infants were enrolled. During PT, the difference plots revealed a wide TcB-TSB disagreement; 95% agreement limits of data indicated that TcB could underestimate bilirubin levels by up to 132 μmol/L at forehead and 157 μmol/L at sternum (Mean difference ± SD of −52.4 mmol/L ± 40.7 at forehead and −69.2 mmol/L ± 42.5 at sternum) and a poor TcB-TSB correlation (r = 0.72 at forehead and 0.51 at sternum). In post-PT phase, correlation coefficients improved significantly and were equivalent to the estimates before the onset of PT (r = 0.88 at forehead and 0.87 at sternum). The analyses of difference plots revealed that TcB could underestimate bilirubin levels up to 88 μmol/L in this phase (Mean difference ± SD of −28.8 mmol/L ± 30.5 at forehead and −19.6 mmol/L ± 34.7 at sternum). Conclusions: JM-103 device is unreliable for estimating bilirubin during PT. However, TcB-TSB agreement improved substantially in the post-PT phase such that use of the TcB device could lead to a reduction in blood sampling during this phase.

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